Research has shown that frequent users of health care services tend to have higher levels of psychological distress. A new study finds that case management reduces psychological distress and creates a sense of security in patients who frequently use health services. In a randomized controlled trial of 247 patients, the intervention group (n=126) received six months of case management including evaluation of patients' needs and resources, a service plan tailored to patients' priorities, care coordination between healthcare and community partners, and self-management support for patients and families. Compared with usual care, the intervention reduced psychological distress (OR 0.43, 95% CI, 0.19-0.95) but had no effect on patient activation. In addition, interviews were conducted with 25 intervention group patients, six case management nurses, and nine health managers, and focus groups were held with eight patients' spouses and 21 participating family physicians. Overall, stakeholders had positive perceptions of the case management intervention. Many noticed that improved accessibility and self-management support led to a sense of security and better self-management of patients' health. The authors note that future research is needed to evaluate the effect of a case management intervention on the use and cost of services and to assess if a longer intervention would result in a change in self-management.
Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study
Catherine Hudon, MD, PhD, et al
Université de Sherbrooke, Québec, Canada